下颌骨区段缺损术后骨性重建对生活质量的影响

Quality-of-life evaluation after microvascular oromandibular reconstruction:A comparative study of reconstucted and nonreconstructed patients

目的分析口腔癌患者下颌骨区段缺损术后骨性重建对生活质量(quality of life,QOL)的影响。方法17例因口腔癌而致下颌骨区段切除的患者按重建术式的不同分为骨性重建组和非骨性重建组,同时采用SF-36、FACT-H&N和UW-QOL三种量表分别在术前、术后3个月和术后12个月进行生活质量的测量,比较两组患者生活质量的差异及纵向变化趋势。结果两组患者术前生活质量的差异无显著性,而在术后3个月和术后12个月两个时点,骨性重建组均有较好的外貌、进食、功能状况和总体生活质量(P<0.05)。术后12个月时,骨性重建组的生活质量恢复到了接近术前水平,而非骨性重建组仍遗留有较严重的口腔相关的特异性问题和较差的功能状况。结论下颌骨区段缺损后的骨性重建能改善患者的外形和功能,提高患者术后的QOL,值得在临床上推广使用。

Objective To analyze the impact of reconstructive procedure on the quality of life （QOL） of patients who had undergone segmental mandibulectomy because of oral cancer.Methods Seventeen patients who had undergone segmental mandibulectomy were divided into two groups based on the reconstructive technique utilized. Ten patients were placed in the osseous reconstruction group,7 patients were placed in the non-osseous reconstruction group. Quality of life of all patients was assessed preoperatively and at 3 months and 12 months after surgery by means of three questionnaires：SF-36 （Chinese version）,FACT-H＆N （Version 4.0） and UW-QOL （Version 4.0） which was translated directly. The differences between groups and longitudinal trends over time were analyzed.Results Preoperatively,there was no statistically difference between groups. At 3 months and 12 months after surgery,osseous reconstruction produced a perceived better appearance,better eating ability,better functional well-being and a better overall quality of life （P〈0.05）. The scores of patients in the osseous reconstruction group approached pretreatment level by 12 months; while patients in the non-osseous reconstruction group showed lower values in disease-specific problems and functional well-being by 12 months.Conclusion Restoration of mandibular continuity by free fibula flap after segmental mandibulectomy leads to improved appearance,functional well-being and a superior quality of life. It deserves to be popularized in clinical work.